Acting as a principal, ORI organized, led and financed a consortium with NewYork-Presbyterian Hospital and W.S. Atkins, the British engineering services firm, won a UK government tender in 2004 for a five-year $220 million contract to build and operate a private specialty hospital (an “Independent Sector Treatment Centre’) in England serving 12,000 National Health Service patients annually with elective short stay inpatient and ambulatory procedures in orthopedics, ophthalmology and general surgery.

When the contract with the Government was signed in 2004, ORI founded a UK company, UK Specialist Hospitals Ltd., (UKSH) along with an equity partner (funds associated with Lord Jacob Rothschild) to construct, equip, staff, open and operate the specialty hospital and to develop new hospital facilities in the UK. The initial specialty hospital—the Shepton Mallet Treatment Centre in Somerset—was constructed, staffed and opened in 46 weeks from the signing of the contract, on time and on budget.

It is widely viewed by Government and other observers, as the best hospital in the Independent Sector Treatment Centre program. Viewing performance nine months after opening, a study done for the Government found the Shepton Mallet hospital to have significantly higher productivity and considerably better clinical performance than typical National Health Service hospitals (see chart to the right).

Performance has improved since then. The center has 4.0 day lengths of stay for total joint replacement, clinical complication rates on par with those of the best US and international institutions, and 100 percent of patients surveyed state they will come again and recommend the Center to relatives and friends. Based in part on this record, UKSH won a second, $310 million, six-year Government contract to develop and operate three new specialty facilities in Bristol, Wiltshire and Gloucestershire. These new facilities opened in November and December of 2009. UKSH has been designated Preferred Bidder for a fifth specialty facility that will open in the third quarter of 2010.

ORI’s Roles and Tasks

Prior to the founding of UK Specialist Hospitals, ORI led the work to:

• Hire and organize the largely UK team that responded to the UK Government tender
• Develop the detailed business case for the hospital along with the space, equipment, organization structure and staffing plan, and set out processes and procedures for the hospital
• Negotiate and finalize the contract with the UK Government
• Negotiate the design and construction contracts for the rapid, modular construction of the hospital with major incentives for on-time performance
• Oversee the design of the hospital to meet efficient US space utilization precepts
• Negotiate the affiliation arrangement with NY Presbyterian
• Negotiate and conclude all debt and leasing financing arrangements for the initial hospital
• Negotiate and conclude the deal for equity financing of the new company
• Recruit and hire the administrative leadership for the new company

ORI is a shareholder in UK Specialist Hospitals and has maintained a management contract with the company since its inception. ORI’s Chief Executive Officer is the Chairman of UKSH. ORI’s Chairman serves on the Clinical Advisory Board of UKSH as well as UKSH’s Board. In addition to general oversight and governance roles, ORI has particular responsibilities in identifying and developing new hospital projects, and in refining U.S.-based best-practices for UKSH’s operations.

In the latter regard, Shepton Mallet’s performance success stems in large part from a detailed and rigorous application of U.S. best practices, including:

• Guidelines for preferred use of regional anesthesia, early application of physiotherapy in the post-operative period, among many evidence-based, pragmatic clinical best practices
• Use of ambulatory rather than in-patient approaches where appropriate
• Efficient teamwork in managing down peri-operative case times and room turn-around times
• Service standard-setting to assure, for example, patients receive substantive care and attention shortly after appearing at the facility
• Extensive patient education pre admission and post discharge, with uniform post-discharge follow up.

The Center’s performance is a demonstration that these best practice approaches can be adopted effectively by a largely UK administrative staff, a doctor staff drawn largely from EU countries and a nursing staff drawn largely from the UK itself.

Go to the UKSH website here: www.uk-sh.co.uk

Download the Department of Health PDF press release here.

Clinical Outcomes Report 2006 – 2007

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